Laparoscopic Paraduodenal Hernia Repair

Paraduodenal hernias are the commonest type of internal hernia, affecting 2-3% of the population. Paraduodenal hernias arise from a deficiency in midgut rotation. However, unlike malrotation, the duodenum crosses the midline and the cecum is located in the right lower quadrant. 75% of paraduodenal hernias are left sided. The peritoneum-lined sac, known as Landzert’s fossa, resides in the mesentery of the proximal descending colon. As the sac enlarges with development, paraduodenal hernias become symptomatic, causing intermittent abdominal pain in adulthood. These hernias can be complicated by small bowel obstruction, ischemia, and necrosis. Thus, such hernias, especially when symptomatic, must be surgically repaired.

We present a case of a healthy 42 year old physician with a several month history of intermittent, diffuse abdominal cramps. He denied any nausea, vomiting, or changes in his bowel movements. Blood tests, stool studies, upper endoscopy and abdominal ultrasound were normal. A computed tomogram of the abdomen and pelvis eventually demonstrated a left-sided paraduodenal hernia without evidence of obstruction or ischemia.

Our video submission describes the two types of paraduodenal hernias, illustrates the anatomical landmarks of Landzert’s fossa, and demonstrates the laparoscopic reduction and closure of our patient’s paraduodenal hernia. The patient was discharged on post-operative day one, tolerating a regular diet, with no evidence of recurrence on six month follow-up. Our case represents only the ninth reported case of a laparoscopically treated left paraduodenal hernia.